The Role of Insurance Networks and Organizational Factors in Guideline-Concordant Care for Serious Mental Illness

项目总结 严重的精神疾病影响了超过5%的美国人口，但只占一小部分 这些人中有20人得到了适当的治疗。精神分裂症影响了1%的人口，而且 尤其令人衰弱。精神分裂症患者的健康和社会后果不良率很高， 包括过早死亡、无家可归和吸毒。精神分裂症患者在 自杀风险增加，并有很高的并存疾病发生率。指导方针-和谐关怀(GCC)- 包括适当的药物和心理治疗--改善精神分裂症患者的预后， 包括死亡率。然而，GCC的发病率很低，在不同的患者群体中存在显著差异。 分组、临床情况和临床医生类型。尽管有些差异可能是由患者来解释的 保险和组织层面的偏好、制度因素可能是GCC低费率的原因。 更好地了解系统因素--包括保险网络和组织的作用--有助于 引导治疗路径走向GCC，改善患者预后是对 改善精神分裂症患者的临床实践。根据PAR-19-189的目标， 这项试点服务研究的目标是确定与可获得性和可得性相关的可变医疗保健系统因素 精神卫生服务的质量。使用全面的医疗保险投保和索赔数据 马萨诸塞州我们量化和检查精神分裂症患者保险网络的变化，检查 这些网络特征的关联-包括大小和组成(反映心理上的可用性 健康临床医生)-与指南的患者结果-一致的护理接受和自我伤害。作为一种潜力 了解保险网络如何影响患者结局的机制，我们检查 组织特征--心理健康临床医生的组织规模和比例-- 与病人的结果有关。我们对首发精神病患者进行敏感度分析。 对这一人群进行全面护理的临床紧迫性和政策利益，并建立一个因果关系 使用年轻人样本的保险网络和组织之间的关系和结果。 了解与GCC相关的因素和结果将有助于确定有效的政策杠杆来改善 关心。这项初步研究的结果将指导未来在精神健康服务提供方面的改进，以及 确定未来研究影响关键系统特征的政策变化的途径。

PROJECT SUMMARY Serious mental illness affects more than 5% of the United States population, but only a small proportion of these individuals receive adequate treatment. Schizophrenia impacts one percent of the population and is particularly debilitating. Individuals with schizophrenia have high rates of poor health and social outcomes, including premature mortality, homelessness, and substance use. Individuals with schizophrenia are at increased risk of suicide and have high rates of comorbid disease. Guideline-concordant care (GCC) – including appropriate medications and psychotherapy – improves outcomes for individuals with schizophrenia, including mortality. However, rates of GCC are low, with significant variation across patient demographic groups, clinical conditions, and clinician types. Although some differences may be explained by patient preferences, system factors at the insurance and organization levels likely contribute to low rates of GCC. Better understanding system factors – including the role of insurance networks and organizations – that help guide treatment pathways towards GCC and improve patient outcomes is an important contribution to improving clinical practice for individuals living with schizophrenia. Pursuant to the goals of PAR-19-189, the objective of this pilot services research is to identify mutable health care system factors related to access and quality of mental health services. Using comprehensive health insurance enrollment and claims data from Massachusetts we quantify and examine variation in insurance networks for those with schizophrenia, examine associations of these network characteristics – including size and composition (reflecting availability of mental health clinicians) – with patient outcomes of guideline-concordant care receipt and self-harm. As a potential mechanism for understanding how insurance networks may influence patient outcomes, we examine associations of organizational characteristics – organization size and proportion of mental health clinicians – with patient outcomes. We conduct sensitivity analyses limiting to individuals with first episode psychosis due to the clinical urgency of comprehensive care and policy interest in this population, and establish a causal relationship between insurance networks and organizations and outcomes using a young adult sample. Understanding factors associated with GCC and outcomes will help identify effective policy levers to improve care. Findings from this pilot study will guide future improvements in mental health services delivery, as well as identify avenues for future research on policy changes influencing critical system characteristics.